Provider Demographics
NPI:1053574400
Name:TREADWAY, ANGELA GRAYCE (DPT)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:GRAYCE
Last Name:TREADWAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 IH 35 N # 315-227
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5003
Mailing Address - Country:US
Mailing Address - Phone:512-851-7070
Mailing Address - Fax:949-561-4547
Practice Address - Street 1:4107 MEDICAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3736
Practice Address - Country:US
Practice Address - Phone:512-851-7070
Practice Address - Fax:949-561-4547
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist